POULTRY SUPPLEMENTAL APPLICATION

Transcription

1 POULTRY SUPPLEMENTAL APPLICATION Note: All no answers or undesirable features should be referenced by question number and explained in the comments section at the end of this application. Applicant Name: Contact Name/Number: 1. Current/ Prior Carrier: Expiration Date: Expiring Premium: 2. Losses in past 5 years? 3. If yes, please describe in full detail: *** (Three(3) year hard copy loss runs are required to bind coverage) *** 4. How long has the applicant farmed? 5. Does owner or farm manager live on site? 6. How many years has the applicant owned a poultry farm? 7. Name of the Poultry Integrator/Company that the applicant is contracted with? 8. Has applicant contracted with any other Poultry Integrator/Company? a. If yes, how long? b. Why did they change? c. Does the insured contemplate any change in their Poultry Integrator/Company in the next 12 months? 9. Building(s) are Occupied or Vacant? If there are any vacant buildings are we being requested to insure them? 10. What is the type of confinement operation? Commercial Eggs Pullets Breeder Hen Broiler 11. Financial evaluation a. How many years has the applicant been with the integrator? b. What is the applicant s standing with the Poultry Integrator/Company? Top 10% 11% 33% Below 33% New Grower/Integrator Relationship c. Have the houses been without an integrator contract within the last 5 years? d. Type of contract with the poultry company (integrator)? Flock to Flock Multi Year End date e. How does the applicant typically settle when birds are processed? Above Average Average Below Average f. How many flocks does the applicant raise per year? g. Have you been on any type of grower improvement program in the past 3 years? If yes, please explain. Edition 4/14/2015 1

2 12. Have Safety programs been formalized for: a. Fire Control (fire extinguishers/ other systems)? b. Saw dust/shavings or hay storage (moisture control)? N/A c. Is there a Biosecurity plan (Controls in place to prevent disease and limit unnecessary exposures by visitors)? A written plan Verbal controls in place Biosecurity plan loosely followed d. Is there 24 hour on site security (someone lives on premise full time)? e. How do you dispose of your birds? i. If composting is there a spontaneous combustion prevention program in place? f. Do you use an ammonia product between flocks? i. If yes, is there environmental safety (ammonia control)? 13. Generator a. Do the confinement houses have an emergency backup generator with automatic transfer switch? b. Is the generator tested under load weekly? c. Is the generator weather protected and well ventilated? d. Is the generator in a separate unconnected building? 14. Housekeeping and Maintenance a. Are confinement buildings cleaned out at least 1 time per year? b. Is housekeeping around all confinement buildings, sheds, barns, etc. free of excess debris and clutter? c. Are Measures taken to control dust and cobwebs evident? d. Is the grass mowed and kept around all confinement buildings, sheds, barns, etc.? e. Are the control rooms clean and free of clutter (especially paper)? Any Flammables? f. Is there a rodent control program? g. Is there any evidence of rodents or rodent damage? h. Is the interior of confinement buildings free of non essential items, clutter? i. How many portable fire extinguishers are in each poultry building? (0) Zero (1) One (2) Two or more j. Is there a scheduled maintenance program? k. Is there a preventative maintenance program? l. Is smoking allowed on premise? If yes: Are there designated smoking areas outside only with proper receptacles? Are there designated smoking areas without proper receptacles? No smoking rules in place 15. Construction Edition 4/14/2015 2

3 Building Location Building name/reference Vacant (Y/N if Y, since what date) Year Built Length Width Trusses/Legs (wood/metal) Roof Attachment (screws/nails) Distance between trusses (inches) Foundation * construction Hurricane straps Metal knee braces Wooden Knee Braces Are knee braces properly installed? Year Electric upgrades Year Mechanical upgrades Perils Limit of Insurance Valuation (ACV/RC) Deductible Earthquake Edition 4/14/2015 3

4 Mine Subsidence * Foundation Construction: TL= Treated Lumber C=Concrete CB= Combination 16. Structural Evaluation a. Confinement houses built by? Applicant Purchased from others b. Were the confinement buildings designed by a professional engineer? c. Were the trusses designed and stamped by a professional engineer? d. Do trusses show any structural defects (bowed, missing plates, large cracks, etc.) If yes, please explain in full detail: e. Were the buildings engineered for the appropriate wind zone, according to the International Building Code wind speed map? f. What type of foundation/ wall construction does the building have? Chain Wall Curb Wall WITH Solid End Doors Curb Wall WITHOUT Solid End Doors Post in Ground WITH Concrete Footer Post in Ground WITHOUT Concrete Footer Chain combination of treated wood and reinforced concrete Curb reinforced concrete only Post treated wood only g. Do all confinement buildings have knee braces connecting each truss to each sidewall post? If Yes, what kind of knee braces exist? Metal Wood h. Is the insulation covered with fire retardant material? i. What is the distance between buildings? (diagram available?) j. Are any of the confinement buildings connected by a common room or other structure? If yes, is there a firewall or minimum 2 hour Fire Barrier with a self closing 1 ½ hour fire door at all openings where the buildings connect? k. Were the buildings built for use as a confinement operation? l. Were the buildings built by a licensed contractor? 17. Electrical a. What is the location of the control room for each confinement building? End Middle No Control Room Are the Breaker Boxes and Controllers located inside the grow out portion of the poultry house? b. Is an electrical inspection done annually by a licensed electrician? c. Are all electrical panels properly grounded? d. Is the controller capable of remote contact with the applicant in case of emergency? e. Are the confinement buildings operated by a controller (computer)? Edition 4/14/2015 4

5 f. Are there back up thermostats? g. Are controllers surge protected? h. Are electrical cords securely fastened away from fans? i. Are there adequate outlets to avoid multiple plugs and extension cords? j. Are circuit boxes fittings and electrical outlets properly maintained and covered? **Fuse boxes are ineligible for coverage** 18. Heaters a. Is there an incinerator on the premises? If there is an incinerator in use, is it located at least 100 feet from the nearest building and does the incinerator have a screen on top of it? b. Are heaters inspected regularly and serviced/replaced? c. What type of fuel is used in the confinement buildings? LP NG Wood Biofuel d. What type of heaters? Radiant Brooders Radiant Heaters Gas Fired Furnace Other: e. Are there any open flames? f. Do heaters have heat shields? g. Are heaters at least 12 from the ceiling? h. Are all flexible hoses used for gas supply lines to the heaters approved for use with LP and Natural Gas? i. Are gas tanks located in a safe location? The undersigned is an authorized representative of the applicant and warrants and represents that commercially reasonable efforts have been made to obtain true and correct answers to the questions in this document. The undersigned further warrants and represents that the answers to the questions in this document are true, correct, and complete based on such efforts. The undersigned understands and agrees that he/she will be held responsible for any knowing misstatement or misrepresentation in the answers contained in this document. Policyholder or Representative Date Insurance Agent Representative Date Comments: (explanation of all no answers or undesirable features referenced by question number) Edition 4/14/2015 5

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